Your Questions
Your Questions
Q: Dr. Eppley, I just want to have a strong chin and don’t want to narrow it, I think from side view my chin is receding and weak. Please take a look at my photos and give me some advices, what should I do with my chin , I want to bring it forward as much as possible and in your website I see amazing before and after photos, your work is very artistic. If I were in the US I would have flown to your clinic today but unfortunately I am far away and I can’t afford to come for a surgery. If you know someone in overseas who you think his work is excellent please recommend me so that I perform my chin surgery some months later. I may refer to any doctor based on your recommendation because I have trust and confidence in you. You know finding a good doctor is very important.
A: Based on your photos, your chin deficiency is very mild and you already have good chin width in the frontal view. I would recommend an implant as opposed to an osteotomy. This is the most assured way of getting better horizontal as well as transverse width increase. An osteotomy will bring your chin forward but will also make it more narrow as well. Otherwise, I have no surgeon recommendations for you in your part of the world as I simply do not know any surgeons either professionally or personally.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, because of an accident at an early age I had some weak chin and facial asymmetry on the right side. Four years ago I had a chin implant whichi resulted in horrible deep hollows on the side of the chin. My chin implant was a button type. So I’ve had three fat grafting surgeries to correc the hollows and also using fat to lessen the asymmetry. (underdeveloped right side of my face) The results are not bad but still lots ofasymmetry and the fat is starting to melt unevenly so I am looking for a more radical solution. I want to remove the button type implant and replace with an extended anatomical chin implant as well as jaw angle implants to look more solid. What is yourt suggestion about this? Thanks a lot.
A: I would agree that changing the chin implant to an extended style is much better for a male than a central button style. The jaw angle area could be permanently enhanced by lateral extension jaw angle implants. The only area that will not be filled in as well is the area between the two. But I don’t think in your case that would justify custom implants to be made. Fat has been a good intermediary step to see if the changes are favorable but it is definitely not a permanent solution. The combination of chin and jaw angle implants provides a permanent volume solution to jawline enhancement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in having Smart Lipo to remove some fat on my chin. However, I have a chin implant that I got 16 years ago. One doctor told me that the risk of infection would be higher and the heat from the laser could move or melt the implant. He advised me to get another opinion and to ask the doctor before I make the appointment because some doctors’ immediate answer may be no. Can you please tell me about the risks and whether this is a good idea or not. Thanks very much.
A: My question to you is what you mean by ‘chin liposuction’. Do you mean having liposuction on the chin pad proper (which is highly unusual and associated with risks of irregularities) or do you mean liposuction under the chin area, formally known as the submental region?
Either way, I would see no negative effect of the laser probe on a chin implant. The location of a chin implant is deep and against the bone and is beneath the fat layer of the chin. There is also the mentalis muscle which exists between the chin fat pad and the implant. In addition, the melting temperature of polymerized silicone is quite high (over 350 degrees F) and the heat generated by a fiberoptic laser probe does not create or should not create field temperatures higher than 145 degrees F. In addition, inadvertent touching of the end of the laser probe to the implant (which should not happen based on the previous description of where the implant is located) will still not cause it to melt.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 22 years old and am bothered by my small lower jaw. It is small with about a 1/2 inch discrepancy between my upper and lower teeth. I really dislike my profile. I had an appointment with an orthodontist last week and he recommended getting braces and then having a lower jaw advancement. This sounds too extreme to me. I was wondering if I can just get a chin implant if I’m that unhappy with my looks. If you were me what would you do?
A: Your dilemma is a classic one and the decision is ultimately affected by a patient’s age, whether they have any masticatory functional symptoms, the magnitude of the jaw discrepancy and what they are willing to go through. From a long-term standpoint at your young age, both functionally and aesthetically, you should have the combined orthodontic and jaw advancement surgery. It is most certainly not extreme and is a routinue maxillofacial surgical procedure. A chin implant, while comparatively simple and providing an immediate aesthetic benefit, would offer no functional improvement for your bite, jaw function and TMJ health.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need your help as I have no jawline. My chin is very short, the neck seems to be missing and it appears as I almost have no lower jaw. This gives a profile that I am very self-conscious about. I make every effort so people don’t see me from the side. I know you are an expert in facial surgery based on your writings and patient photos so what do you recommend?
A: Lack of a well defined jawline and neck angle can be due to any one or combination of the following; chin/lower jaw bone prominence, fullness/fat in the neck and loose neck and jowl skin. Most commonly, the combination of a chin implant and neck liposuction can make a dramatic difference in the younger patient who often has a short chin and full neck. In older patients the sagging skin factors in significantly and some form of a jowl or necklift may be needed. There are exception to these two categories, such as the early aging facial patient with a good chin prominence who just needs some neck contouring through a procedure known as submentoplasty. But when someone describes themselves as having ‘no jaw’, this would indicate the problem is more than just one of the three anatomic components that make up the neck angle and jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have previously sent you photos of me for consideration of a rhinoplasty and a chin augmentation. You sent back some imaging results and, after reviewing them, I have a few questions:
1) Rhinoplasty – I like the overall effect! I just wanted to ask if there was anyway you could make the bridge a little more concave, and if it would also be narrower from the frontal view, and if the tip might be narrowed as well? I know you said that you usually provide an image of the minimum effect that could be achieved, and if this is it, that’s great – I’d still be happy with the improvement.
2) Chin – I think I like the implant a little more than I like the osteotomy, though of course it doesn’t fix the underlying skeletal problem. I might still consider the implant but I haven’t decided.
3) Cheeks – One more question regarding my “chipmunk cheeks”. While my friends and family call them “endearing”, I”ve always wondered if I couldn’t have a little less of a balloony cheek especially right below the corner of the mouth. Is there any way of filling in the tissue right at that spot, or (I guess) of removing fat from the cheek (though I do like my dimples!
Thank you for taking the time to answer my questions and being patient with me!
A: In answer to your questions:
1) Ideally I would like the front view rhinoplasty result to be more narrow, and it may be possible, but your thicker skin may preclude that from happening. For this reason, I have imaged it so that the amount of narrowing will reflect what I believe will happen… but I am pulling for more.
2) I would agree that the implamt effect, while not providing as much horizontal advancement as an osteotomy, seems to be more ‘natural’ looking. It is always best in chin augmentation in a female to be less rather than more. That still preserves a feminine look.
3) You are referring to what is known as the perioral mounds. a cheek fat area that is below the buccal fat pad. That can be effectively treated by small cannula liposuction done from inside the mouth.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I went in recently for a consultation from an Indianapolis rhinoplasty surgeon. During the consultation he recommended a chin implant with my rhinoplasty surgery. While he seemed very honest in this suggestion, I was completely floored as I never thought I had any chin problem. I certainly didn’t think that I had a weak chin. Having had the idea settle in for awhile, I am now more comfortable that maybe I do need one. I like the way my face looks in every way except for my profile which is why I want my nose done. What I am concerned about is that the combination of a rhinoplasty and chin implant will change my face too much. I have attached a profile picture of me for your thoughts. What would you do if you were me?
A: It is not uncommon to perform a rhinoplasty and chin implant together and it can be a powerful changer of one’s profile. But whether it is aesthetically beneficial can actually be determined by you. Make sure that you have done a series of predictive computer imaging. Have shown to you how your profile would look both with and without a chin implant with your rhinoplasty prior to actually undergoing surgery. These images will answer your question better than anyone simply telling you one way or the other. One cautionary note, if you opt for chin augmentation your plastic surgeon needs to be careful about the style and size that is selected for implantation. You have a retruded but long chin. It would be easy to end up with too strong a chin appearance afterwards if the right chin implant is not chosen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interesting in what you refer to as an extreme chin augmentation (osteotomy and an implant). I have a short lower jaw, but unfortunately have been told I’m not a candidate for orthognathic surgery due to the position and condition of my teeth. To help correct this problem, I have had a chin implant placed but the results do not satisfy me as it is not big enough. I am attaching a copy of my ceph x-ray. I do not have a profile picture at this time, but it is pretty clear where my chin is from this x-ray. Can you please comment on having this surgery? I have seen a lot of your before/after pictures on other sites for chin augmentation and am very impressed with your work and the knowledge you seem to have from the questions you answer on your site.
A: Thank you for your inquiry and sending your ceph x-ray. You do an underlying significant lower jaw deficiency as seen on your film. Your current indwelling chin implant provides only 7mms horizontal projection and is positioned just slightly high on the bone. Your true chin deficiency is more in the range of 16 to 18mms deficient. You therefore already have half of an extreme chin augmentation with the existing implant in place. You now need a chin osteotomy done just above your existing implant to advance the bone (carrying the implant) forward about 10 to 12mms with a vertical opening of 2 to 3mms. This will create the most ideal chin projection for you. So doing the previous chin implant was not a wasted procedure. You would have needed it anyway as the bone can only be brought forward so far. i have done some computer imaging and predictive tracings on the ceph x-ray that you have sent me.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have a chin implant to add length to the lower half of my face. However, I am 21 years old and have partially erupted wisdom teeth that I have neglected to have removed for several years. Is it necessary to have them removed before getting a chin implant?
A: The only thing that a chin implant and wisdom teeth have in common is that both occur on the mandible or the lower jaw. But beyond being on the same bone, there is no correlation between the two. The wisdom teeth or third molars are located at the junction of the body and ramus of the mandible at the back. A chin implant is done on the symphysis or front part of the lower jaw. One does not affect the other. However, if you need both done it would be most convenient that they are done during the same surgery. I have done that combination numerous times. The key to this surgical ‘opportunity’ is to find a surgeon who is qualified to perform both procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had cheek and jaw angle implants last year. While I think I look better, I still feel my face does not have enough definition and is still a little too round. What do you recommend that will help my facial aesthetics? I have attached some before and after pictures from my previous surgery.
A: Thank you for sending your pictures. I think you have achieved some facial highlights from your previous procedures but implants also add width and volume. In certain faces this can make one’s face look a little ‘fatter’ or fuller and not always provide the definition that one wants. This can be particularly true with jaw angle and cheek implants. To create some further facial refinement, I would recommend buccal lipectomies to slightly narrow the area below the cheek implants, a chin implant with a prejowl extension to smooth out the jawline better (your chin is slightly deficient and there is a notch in the jawline at the prejowl area) and possible a jowl tuck-up to remove some skin along the jawline an give it better highlights and a possible thinning rhinoplasty. The goal now is to create more definition in your face and help better highlight the facial features that you now have.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am a 19 y/o male with a receded lower jaw along with a very small chin. I am very unhappy with my profile and unable to afford corrective jaw surgery nor do I wish to deal with orthodontics for over a year. I have had braces before when I was younger and do not want them again. I want my chin to look masculine and large but not abnormal. At the moment my mouth and nose stick out farther than my chin. I would like my chin to go out farther than, or at least in line with my mouth. Any advice or help you can offer is very much appreciated.
A: Thank you for sending your pictures. Your chin deficiency is significant enough (at least 12 to 15mms) that a chin implant alone will not suffice. No chin implant is made that can bring the chin far enough forward. Rather than an implant, you need a chin osteotomy (not a jaw osteotomy) which is to cut and move the chin bone forward. That will bring the chin forward about 12mms. In addition, it also has the advantage of vertically lengthening the chin which an implant alone can not do. If you then add a chin implant in front of or on top of the chin osteotomy, you can then get the more ideal result that you are after from a horizontal projection standpoint in a profile view.
Dr. Barry Eppley
Indianapolis Indiana
Q: I tried to do some computer imaging of my face on some programs that some plastic surgeons have but it didn’t seem to work. I just couldn’t make it look right. I am interested in jawline enhancement and facial implants and was looking for some advice. I have attached some pictures for you to review and image.
A: An increasing number of websites, plastic surgeons and otherwise, and smartphone apps have interactive programs in which to do some of your own computer imaging of your face and body. By simply uploading a picture or two, you can do a little ‘Photoshop‘ plastic surgery. While these programs are certainly cool and fun, they are not particularly accurate. That is because of the simple fact that the ‘driver‘ has no realistic appreciation of what can really be done and what actually will happen if certain procedures are done. Only a plastic surgeon can add that missing element if one wants to make the transition from fooling around to seriously considering becoming more than just manipulated pixels.
But there are a few patients in which even the simplest change just don’t seem to look right. That is because their facial anatomy is different and the basic rules of changes do not work well for them. That happens to be the case with you. Your underlying problem is that your lower face is too short for the rest of your face. This shortness affects both your lower and upper jaw. So when you try and just move the chin forward, it doesn’t look right. It makes the midface (upper jaw and upper lip) look retruded or back too far. That relationship would be impossible for you as a patient to figure out. What you really need is a treatment that can move both the middle and lower third of your forward. That could be either chin and paranasal implants or orthognathic surgery that moves both the upper and lower jaws forward.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hi Dr. Eppley. I have seen four different plastic surgeons seeking improvement in my facial profile and, so far, nobody can show me or even tell me that by doing “this” or “that” I would get the end result I’m looking for. I’m so scared to have the wrong procedure(s) done, or to chose the wrong size of chin implant, you can’t imagine. I have attached some pictures of myself so you can see my chin and neck problem. After reviewing them s there a way we could communicate by phone? I really need to ask you some questions. I would like to thank you for doing this for me. You are my last hope!!! Please reply, thank you.
A: Quite frankly, I am not sure what the mystery is when it comes to making the facial improvements that you want. Yours is a very straightforward and common problem that I see all the time. It is the classic ‘ying and yang’ problem. The chin must come forward and the neck angle must go back. And how to do that is similarly not a mystery. The chin implant should bring the chin no further forward in a woman than a vertical line dropped down from the edge of the lower lip. In the frontal view, it must be a tapered chin implant so as the chin comes forward it remains with a more feminine shape and not becomes more square or too masculine. From the neck standpoint, liposuction is certainly needed. The only unknown, and I can not tell this from photographs or computer imaging, is what the neck and jowl skin will do. Is it good enough quality skin to tighten up on its own or does it need a little help via a jowl-neck tuck-up from incisions around the ears?
I have attached some predictive computer imaging so you can have an approximation of what the outcome from a combined chin implant and neck liposuction and recontouring procedure would be. It is unfortunate that after four plastic surgery consults, this ‘mystery’ has not become unveiled to you.
I am happy to talk to you by phone or Skype any time. Just let me know your availability and we can work out a time.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am considering having augmentation for my short chin. I am confused as to whether to use an implant or move the bone. Doctors seem to recommend both ways and it is not clear as to which way may be best for me. Can you help me decide?
A: Your two main choices for chin augmentation are either an implant or a sliding osteotomy. Both will work and each has its own disadvantages and advantages. An implant is simpler, has a quicker recovery and can make the chin wider as it comes forward. (if you want to change your v-shaped chin in frontal view to a more round or even a more square shape) There are even square chin implants to help create that look. The only disadvantage is that it is an implant…although I don’t really see any lifelong problem with having an implant in the chin. That is a very safe place for a facial implant and it is not likely to ever cause any problems requiring its removal. The osteotomy involves moving the chin bone instead of an implant. It is a ‘bigger’ operation, requires a plate and screws and thus there is more expense. It’s main advantage over an implant is that it is better at increasing the vertical length of the chin should that be needed. An implant can not do that very well at all. Also in big horizontal advancements (8 to 10mms or more) in a young person, moving your own chin bone forward is probably better than having a big implant on the end of the chin. An implant can deepen the labiomental sulcus whereas an osteotomy can keep it from getting deeper than where it started. This means that it may look more natural in the long run for big chin advancements.
In the end, you have to look at the anatomy of your chin deficiency and determine whether an implant or osteotomy can correct it the best and the most natural. Other important consideration are your age and the economics of the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q:I had a genioplasty to move the chin forward and now i want to do another surgery that doesn’t involve implants to make the chin wider. Is that possible and will the chin resorb after awhile because of splitting the chin and expanding it in the horizontal direction?
A: As you have discovered, moving the chin forward by an osteotomy will usually make it appear more narrow or tapered. This is because of simple geometry. If you move the front part of an arc forward (think of the lower jaw as u-shaped or an arc), it will make the overall shape of the total arc longer but more narrow in front. For this reason in male patients, I evaluate the front shape of the chin very carefully so if an osteotomy is performed for advancement, and the patient wants the chin to end up wider, I factor that into the osteotomy design and plan a central osteotomy with expansion.
Certainly a second chin osteotomy can be done and the downfractured chin segment split and expanded. It will be held apart by the necessary plates and screws needed to fix the overall osteotomy into position. This should not cause the bone segment later to undergo any resorption. A simpler method to get chin width expansion is to place a chin implant in front of or on top of the bone. There are chin implant styles that provide lateral fullness without any significant horizontal advancement and they would be a good choice here also.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Can a chin implant be an alternative route to mandibular advancement? I went to the orthodontist today for my overbite and excessively gummy smile and was told that my options are to get the Lefort maxillary surgery (or place 2 screws on my upper jaw and have wires pull my teeth-in sections via braces- upwards to reduce the gummy areas) and mandibular advancement. Read about LeFort and mandibular advancement and don’t think I want to go through all the pain and side affects so I looked into chin implant and I am entertaining the idea of a chin implant and the 2 screw method to pull my teeth upwards….. any suggestions?
A: Both chin augmentation and mandiibular advancement will have similar effects on the chin…bringing it further forward. How much each approach will bring it forward is more adjustable with a chin implant as different sizes can be chosen. In mandbular advancement, the chin will only be brought forward as far as the jaw comes forward and the teeth still fit together properly.
Chin augmentation is certainly a far easier and more efficient choice if the primary motivation for the surgery is the aesthetics of the chin. But it will not obviously change one’s bite so there may be some functional chewing and temporomandibular joint tradeoffs if the lower jaw is significantly short.
Mandibular advancement is a commitment both in orthodontic preparatory time and in surgical recovery. Therefore the amount of jaw shortness and how well one is able to chew and bite comes into play as to whether this effort is worth the risks.
Indianapolis, Indiana
Q: have a older button style chin implant and would like to replace it with a new one. I want a chin implant that creates a more masculine look with lateral fullness in the mandible area and a more squared off appearance to the chin. I would also like to have a lip reduction to rebalance my facial proportions so that the jaw line is more prominent and the lips less so. Let me know if this is something you can do all at the same time.
A: Older style chin implants were much smaller in size and ‘non-anatomic’ in shape. They usually just fit over the central part or button of the chin, providing only central horizontal augmentation. While such chin augmentation shape can be acceptable in some patients (usually females), it does not provide the best chin shape in most males. It makes the frontal chin shape too triangular. In men, squaring of the chin shape produces a much more pleasing facial change. While profile views shows good horizontal advancement, patients do not usually see themselves that way and using that view as a judgment of the final result can be deceiving.
Today, chin implants come in a wide variety of styles and shapes that can achieve more than just a simple gain in profile lengthening. Men, in particular, often want a more masculine chin look which means a more square frontal shape and one that blends into the side of the jaw without an obvious transition. In addition, some increase in vertical length is often aesthetically desireable.
Chin implants can easily be exchanged in styles and size, regardless of whether they were placed from under the chin (my preference) or through the mouth. Pocket size and positioning may need to be altered but this does not usually involve the extent of dissection and postoperative discomfort that occurred from the first chin implant placement procedure.
Lip procedures can easily be done at the time of chin augmentation, particularly if the path of implant insertion is done from under the chin. (submental incision)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Over a year ago, I had a medium-sized chin implant placed from inside my mouth and I HATED it. Last month I finally had it removed but I don’t look the same. My chin seems to droop a bit. I am going CRAZY over this! Please tell me what I can do!
A: To understand the problem and how to fix it, you must appreciate what any implant in the body does that changes the size of an area. Like a breast implant, a chin implant pushes off of the underlying bone stretching out the overlying soft tissues. As a result, you are gaining more soft tissue which the area needs to look bigger.
This soft tissue expansion can really be appreciated when and if the implant ever comes out. Without the implant’s support, the now extra soft tissue sags creating a classic chin ptosis condition. Some refer to it as a ‘witch’s chin’ deformity. There now is too much soft tissue for the amount of bone or underlying soft tissue support. Furthermore, the mentalis muscle has been detached from the chin bone and likely was not resuspended at the time of implant removal. This muscle problem can particularly arise when chin implants are placed from inside the mouth where the superior muscular attachments are completely separated.
Correction of chin ptosis can be done by two different approaches, based on the severity of the soft tissue sag. If the laxity is mild, then an intramural approach with muscle resuspension using bone anchors works very nicely. If the soft tissue sag is more severe, then an approach from the underside of the chin known as a submental tuck-up can be done for soft tissue removal and reattachment back to the bone.
Another option would be to replace the chin implant with another one (even if it is smaller), but that doesn’t sound like an option in your case.
Dr. Barry Eppley
Indianapolis Indiana
Q : Hello Doctor, I had a chin implant in November 2008. It got infected and had to be removed two weeks later. Now after one and a half years later my chin is still loose and stretched, making my chin look like it is hanging and looks weirdly different. I like to find out if there is a way of fixing this by shrinking and tightening my chin that will hold my face together the way it was before. Thank you for your time and help, hope to hear from you very soon.
A: In placing a chin implant, it is necessary to lift the mentalis muscle off of the bone. Like placing a breast implant, this stretchs the overlying tissues out. As a result, if chin implants are ever removed there is a risk of the tissues not shrinking back down and become ptotic. (sagging off the bone) This is a well recognized chin problem whose occurrence is more likely the larger the chin implant that was used. The risk of chin sagging is also greater if the pathway in which the chin implant was originally placed and removed was done from inside the mouth. (this method separates a greater amount of mentalis muscle)
Chin ptosis, also known as a ‘witch’s chin’ deformity, can be corrected through two different methods. If you want to get the effect of greater chin prominence that you were originally after, replacement of a new chin implant or moving the chin bone forward (chin osteotomy) can be done. This will give more chin projection and pick up the sagging chin tissues. If you are not interested in any further chin projection, then the mentalis muscle must be shortened and tightened to readapt the soft tissues back on the chin bone. This can be done either from inside the mouth using resorbable bone anchors or from an incision on the underside of the chin. (submental tuckup)
Dr. Barry Eppley
Q: I have a problem with my profile. I wish it would look normal or see my jaw line. I always wished to see it. I think this is because I used to sleep with my mouth open when I was a child. I also a rhinoplasty by a bad doctor who made my nostrils asymmetric.:( This was 4 to 5 years ago. I went to someone who offered the lowest fees since I wasn’t earning much at the time. I would like to come to the states from Egypt for corrective surgery.
A: When most people talk about happiness with their profile, they are almost universally referring to the position of their chin. Based on how the lower jaw (mandible) grows and the bite (occlusion) comes together, the horizontal or forward position of the chin will be affected. For most it is an issue of being too short or not ‘strong’ enough particularly in men. Too much chin is far less of a problem although it does exist and it is more of a concern in women rather than men.
Correction of chin shortness can be done with either an implant or osteotomy. (moving just the chin bone forward) Which is better is determined by multiple factors including the amount of chin shortness, age of the patient, and the position of other chin dimensions. (e.g., vertical height) How much or far forward the chin position should be moved can be determined prior to surgery with computer imaging.
Nostril asymmetry after rhinoplasty is not rare and does not necessarily occur because of a ‘bad’ surgeon or that the operation was performed incorrectly. Even a rhinoplasty executed perfectly can still cause some differences in the shape of the nostrils after all is healed. The nostril shape is influenced by the support of the lower alar cartilages and the overlying skin. Both of these can be altered by the healing forces after rhinoplasty, particularly in the soft triangle area of the nostril where there is no cartilage support to resist the contractile forces of scarring. Secondary correction of nostril asymmetry is possible through cartilage or chondrocutaneous grafting of the nostril rim.
Dr. Barry Eppley
Q: I would like to know what the rate of satisfaction is amongst patients that have had chin osteotomies or chin implants when actually they should have had lower advancement jaw surgery? Are they happy with their appearance or do they feel their top teeth extend out too much when they smile?
A: The short answer is yes. But that answer needs a more detailed explanation. The key is proper patient selection and understanding that a chin implant or osteotomy for a mandibular deficient patient is a compromise operation. It is treating the symptoms of the problem and not the primary problem. In other words, one is camouflaging the real defect and accepting whatever (if any) functional problems that may exist.
The idea treatment for a mandibular deficient patient with a malocclusion (Class bite relationship where the lower teeth are behind the upper…an overbite) is orthognathic surgery. Specifically, a mandibular advancement osteotomy with preparatory and postoperative orthodontics. While this is a very effective operation, it requires a commitment of several years of orthodontics, an operation, and the risks of damage to the inferior alveolar nerve. (some permanent change in the feeling of the lip and chin) The decision for mandibular advancement surgery, therefore, should be based on one’s age and the degree of malocclusion. You must balance the risks vs the benefits like any surgery. If one is young with more than several millimeters of overbite, this should seriously be considered and even done. In patients who are older, often with even more significant overbites, the enthusiasm for this surgical effort is often not there. Camouflaging the jaw defect and getting a better profile and improved facial proportions through a simpler chin implant or osteotomy has a lot more appeal.
In my Indianapolis plastic surgery experience, I have never had any unhappiness amongst patients who has chosen the isolated chin route. Nor has it been reported to me that their upper teeth stick out too far when they smile.
Dr. Barry Eppley
Q : I have a weak chin that has bothered me my whole life. I am so self-conscious that I turn away so people can not see me in profile. I also think my entire jawline is weak, it overall looks too small for the rest of my face. Can my jawline be improved with different types of implants?
A: Historically, most people think of jaw enhancement as that of the chin only. Chin implants have been around for over fifty years and have evolved today to include a wide variety of different chin styles and sizes. For horizontal jaw shortness, a chin implant can provide a simple, quick and permanent method of significant profile improvement.
Today, jaw enhancement has progressed to consider changes along the entire jawline from back to front. Besides chin implants, the use of implants to accentuate the jaw angle have become popular. Designed to increase the width of the jaw (and some designs will lower the jaw angle as well), they increase bigonial width and create a stronger and more masculine.
Chin implants are most commonly done as a stand alone facial augmentation procedure. Jaw angle implants can also be done by themselves if an adequately projecting chin already exists. For cases of an overall weak lower jaw, the combination of chin and jaw angle implants together can make for a more dramatic change in jawline appearance. This combination (the ‘jawline trifecta’) is increasingly popular for those men who have a congenitally shorter jaw or for those want to make a stronger jawline out of an otherwise normal sized one.
Dr. Barry Eppley